| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,840 |
2,836 |
$116K |
| D1120 |
Prophylaxis - child |
2,979 |
2,974 |
$89K |
| D1351 |
Sealant - per tooth |
2,905 |
826 |
$57K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
894 |
565 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
821 |
821 |
$51K |
| D0274 |
Bitewings - four radiographic images |
1,996 |
1,993 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,334 |
3,324 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,899 |
3,316 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
440 |
440 |
$21K |
| D7111 |
|
273 |
159 |
$16K |
| D1110 |
Prophylaxis - adult |
162 |
162 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
284 |
182 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
186 |
91 |
$12K |
| D9430 |
|
320 |
310 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
659 |
651 |
$8K |
| D0272 |
Bitewings - two radiographic images |
651 |
651 |
$7K |
| D0350 |
|
405 |
238 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
39 |
25 |
$3K |
| D1999 |
|
36 |
34 |
$0.00 |